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Cablegate: The Second Deadliest Disease in Burma

VZCZCXRO1301
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB RUEHPOD
DE RUEHGO #1027/01 2900337
ZNR UUUUU ZZH
R 170337Z OCT 07
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 6692
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1546
RUEHBY/AMEMBASSY CANBERRA 0605
RUEHKA/AMEMBASSY DHAKA 4635
RUEHLO/AMEMBASSY LONDON 1997
RUEHNE/AMEMBASSY NEW DELHI 4136
RUEHUL/AMEMBASSY SEOUL 7695
RUEHTC/AMEMBASSY THE HAGUE 0656
RUEHKO/AMEMBASSY TOKYO 5254
RUEHRO/AMEMBASSY ROME 0141
RUEHFR/AMEMBASSY PARIS 0554
RUEHCN/AMCONSUL CHENGDU 1223
RUEHCHI/AMCONSUL CHIANG MAI 1137
RUEHCI/AMCONSUL KOLKATA 0089
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUCNDT/USMISSION USUN NEW YORK 1037
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 04 RANGOON 001027

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD
DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART;
OES/IHA/DSINGER AND NCOMELLA
DEPT FOR CA/OCS/ACS/EAP
DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN
HHS/OGHA/WSTEIGER AND MSTLOUIS
USDA FOR OSEC AND APHIS
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM
DOD FOR OSD/ISA/AP FOR LEW STERN
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE
ROME FOR FAO
BANGKOK FOR REO OFFICE
PACOM FOR FPA

E.O. 12958:N/A
TAGS: ECON TBIO EAID SOCI PGOV AMED BM
SUBJECT: THE SECOND DEADLIEST DISEASE IN BURMA


RANGOON 00001027 001.2 OF 004


1. (SBU) Summary. Tuberculosis is one of the deadliest diseases in
Burma, second only to malaria. According to the World Health
Organization (WHO), approximately 40 percent of Burma's population
is infected with TB, although some NGOs argue that up to 60 percent
of the population could be infected. In 2006, health officials
diagnosed more than 107,000 new TB cases, up from 95,000 in 2005.
More than 10,000 people died from TB last year. The Ministry of
Health estimates that 4.4 percent of new cases and 15 percent of
previously treated patients are multi-drug resistant (MDR-TB), which
is more difficult and costly to treat. The WHO warns that
extensively drug resistant TB (XDR-TB) may also exist in Burma,
although statistics are not available. The GOB allots less than
$200,000 annually for its National Tuberculosis Control Program
(NTP), and instead relies heavily on assistance from international
NGOS for TB treatment and medications. End Summary.

The Second Deadliest Disease
----------------------------

2. (SBU) Tuberculosis is one of the most deadly and contagious
diseases in Burma. According to Dr. Hans Kluge, Tuberculosis
Medical Officer at the World Health Organization (WHO), the WHO
classifies Burma as one of 22 countries throughout the world with
the highest burden of TB cases. The WHO estimates that more than 40
percent of Burma's population is infected with TB, although some
NGOs contend that up to 60 percent of the population could be
infected. Kluge noted that while 80 percent of all TB cases in
Burma are found in people between the ages of 15 and 54, one out of
every six children has TB. The mortality rate for TB infected
patients in 2006 was 21 deaths per 100,000 people, or more than
10,500 deaths - a rate that the WHO believes will increase in future
years.

3. (SBU) The Ministry of Health (MOH) reports that health officials
diagnosed 107,991 new cases of TB in 2006, up from 95,000 in 2005.
The MOH attributes the higher rate of detection to improved capacity
of health practitioners at the local level. While Dr. Kluge
acknowledged that the MOH's National Tuberculosis Control Program
(NTP), which receives the majority of its funds from the WHO and
other donors, has improved the detection of TB, he indicated that
the rate of infection is increasing annually. Kluge also
highlighted that of the new cases found in 2006, more than 33,000
tested positive for infectious pulmonary TB, the most contagious
form of the disease.

High Rate of MDR-TB and HIV co-infection
----------------------------------------

4. (SBU) In addition to the high TB contraction rates, Dr. Kluge

RANGOON 00001027 002.4 OF 004


emphasized that the rate of multiple drug resistant (MDR-TB) cases
is also increasing. According to a Drug Resistance Survey conducted
in 2003, the WHO found that 4.4 percent of new patients and 15.5
percent of previously treated patients were multi-drug resistant.
Dr. Kluge, noting that Thailand's MDR-TB rate in new patients
hovered around one percent, emphasized that Burma's multi-drug
resistant TB rates were more than double those of neighboring
countries. Due to Burma's porous borders, it is only a matter of
time before neighboring countries also experience increases. MDR-TB
is a real problem for the Ministry of Health, he explained. Because
a patient is resistant to two or more of the primary drugs used to
treat TB, MDR-TB is more difficult and expensive to treat and has a
higher mortality rate.

5. (SBU) Approximately seven percent of TB patients in Burma are
also infected with HIV, Dr. Hans noted. Additionally, the WHO
estimates that between 60 and 80 percent of HIV positive patients
contract TB during the course of treatment. According to the WHO,
at 2.8 deaths per 100,000 people, Burma has the highest mortality
rate in Southeast Asia of TB patients co-infected with HIV.

High Risk of XDR-TB
-------------------
6. (SBU) Dr. Kluge indicated that extensively drug resistant TB
(XDR-TB) exists in Burma, although the WHO does not have exact
statistics. If a person has MDR-TB, they can develop XDR-TB, which
is resistant to first and second line TB drugs, if drug treatment is
misused or mismanaged, Kluge explained. Because the MOH does not
yet have a plan to deal with MDR-TB, Burma has a greater risk of
XDR-TB cases. In June, French NGO Medecins Sans Frontieres (MSF)
confirmed two cases of XDR-TB among Burmese living along the Thai
border. Dr. Kluge emphasized the need for more research on XDR-TB,
particularly as more people flee Burma.
GOB's Limited TB Budget
-----------------------

7. (SBU) According to Burma's 2001-2006 National Health Plan, the
Ministry of Health considers TB to be the second priority disease.
Under the National Tuberculosis Control Program (NTP), the Ministry
employs 1,028 health workers for TB treatment and prevention,
operates TB centers in the capitals of all states and divisions
except Chin State, and has 47 TB teams covering all 64 districts and
54 TB teams covering 260 of the 324 townships throughout the
country. The Burmese Government allocates approximately $200,000
annually for the control and prevention of TB in Burma. In FY2006,
the GOB allocated 175 million kyats ($135,000) for the NTP, most of
which was used for salaries and administrative costs, and 55 million
kyats ($43,000) for the procurement of TB medicines. Total
expenditures on TB accounted for 0.8 percent of the GOB's total

RANGOON 00001027 003.4 OF 004


expenditures on health.

--------------------------------------------- ---------

GOB Funding for Tuberculosis, 2000-2006
In Thousands of Kyats
--------------------------------------------- ---------
Fiscal NTP Percent Total for Percent Total
Year* Budget Change TB Drugs Change Budget
--------------------------------------------- ---------
2000 20,509 --- 25,000 --- 45,509
2001 62,747 205.9 30,000 20.0 92,747
2002 68,470 9.1 35,000 16.7 103,470
2003 74,943 8.6 35,000 0.0 109,349
2004 109,667 47.5 35,000 0.0 144,667
2005 129,300 17.9 35,000 0.0 164,300
2006 119,955 - 7.2 55,000 57.1 174,995
--------------------------------------------- ---------
Source: Ministry of Health
*Burma's fiscal year runs from April 1-March 31.

8. (SBU) Despite increasing TB prevalence rates, funding from the
GOB has not risen to address the problem, Kluge asserted. The GOB
only provides 6 percent of the NTP's annual budget, and instead
depends on the WHO and donors through the Three Disease Fund (3DF)
for money for the care and prevention of tuberculosis. Under the
3DF, donors have pledged $102 million over five years, with 20
percent going to TB programs. Local and international NGOs, such as
Population Services International (PSI) which receives $2.1 million
in HIV/AIDS assistance from the USG, also provide effective TB
services to the Burmese. (Note: We will report on NGO TB assistance
septel. End Note.)

Connect the DOTS
----------------

9. (SBU) The majority of funding is used for the Directly Observed
Treatment Short Course (DOTS). Under the DOTS program, which was
established with WHO assistance in 1994, a community or health care
worker directly observes the patient swallowing their anti-TB
medications over a six month period. During the first year, the
Ministry of Health established DOTS in 18 townships; it has since
expanded DOTS to all 324 townships. MOH officials underline that
under the DOTS program, 80 percent of TB patients receive treatment.


10. (SBU) Although the Ministry of Health touts the DOTS program as
a success, the WHO is not as quick to applaud the MOH's efforts.
The MOH must expand the DOTS program so that patients in rural areas

RANGOON 00001027 004.4 OF 004


have access to services, Dr. Kluge noted. The MOH should also work
to improve the availability of human capacity, equipment, supplies,
and medicines to respond to TB, he added. Currently, more than 25
percent of NTP staff positions are unfilled, due to high turnover.
The Burmese Government spends too little on TB, and when grants for
medicines, such as the Global Drug Facility grant, expire, the GOB
will be unable to procure the necessary TB medicines. Additionally,
Dr. Kluge informed us that the Ministry of Health still lacks
guidelines on the treatment of MDR-TB and HIV-TB co-infection,
despite establishing national committees to review the issues in
early 2006. The GOB could do more to improve health conditions in
Burma, he noted, but the senior generals choose not to.

Comment
-------

11. (SBU) A health crisis exists in Burma: approximately two
million Burmese are infected with tuberculosis; more than 500,000
Burmese have malaria; thirty-five percent of children under the age
of five are malnourished, with seven percent severely malnourished;
and in 2005, there were more than 28,000 new cases of HIV/AIDS and
approximately 37,000 AIDS-related deaths. The Burmese Government,
however, allocates less than one percent of GDP for health
expenditures, demonstrating the low priority given to the public
health care system. In refusing to provide even the most basic
health care services, the senior leaders continue show their disdain
for the Burmese people. If it were not for the many local and
international NGOs that provide the people with the medical care
they desperately need, Burma's mortality rate would skyrocket, and
the regional threat of a spread of MDR-TB and XDR-TB would
significantly increase. Funding health programs, particularly for
TB, HIV/AIDS, and malaria, is one way the international community
can support the Burmese people, helping them survive the neglect of
their government.

VILLAROSA

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